Department of Urology, Urmia Urology and Nephrology Research Center, Urmia University of Medical Sciences, Urmia, Iran.

Abstract

OBJECTIVE: The aim of this investigation was to assess the efficacy of hydrochlorothiazide as a hypocalciuric diuretic on stone-free rateof renal pelvic calculi after extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A double-blind, placebo-controlled randomized clinical trial was conducted and 52 patients with renal pelvic calculi (diameter ≤2 cm) were enrolled from February 2010 toSeptember 2010. ESWL protocol was performed by 2,500 shocks per session. The patients were randomized into two groups: (1) 26patients who were given 25 mg hydrochlorothiazide twice daily; and (2) 26 patients who received placebo. The stone-free rate was defined as residual calculus size ≤4 mm in controlled ultrasound on 2(nd) week, 1 month and 3 months after ESWL. RESULTS: 19 (78%) of the first group and 9 (42.9%) of the second group were stone-free after one session of ESWL (P = 0.02). 88% of the group 1 and 47.8% of thegroup 2 were stone-free on 1 month after ESWL (P = 0.003); however, this effect of hydrochlorothiazide was not related to the patients' body mass index, age and gender. The accessory treatment procedures were applied in 24% of the group 1 compared with 19% of the group 2 during 3 months (P = 0.68). All patients in both groups were stone-free on 3 months following lithotripsy. CONCLUSIONS: Hydrochlorothiazide did not impact on the stone-free rate and using accessory procedure within 3 months; however, it decreased duration of stone-free status and number of ESWL sessions.

Urol Ann. 2014 Jul;6(3):208-11. doi: 10.4103/0974-7796.134261.

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Comments
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This is not an easy paper. The authors did not formulate a hypothesis they wanted to prove. Like this it is difficult to deal with those five patients (9.6%) of the placebo group and one patient (1.9%) in the thiazide group who discontinued the medication and were simply excluded from the study. In an intention to treat analysis they would be counted as failures.
The stone-free status was examined by - examiner dependent - sonography and defined “as residual calculus size ≤4 mm in controlled ultrasonography at 2nd week, 1 month and 3 months after ESWL session.” It is not clear how many patients were stone free at week 2 and if the hydrochlorothiazide group with 76% one-session-treatments compared to 43 % in the placebo group was just responding better to ESWL. There are no data on the stone composition. The numbers are too small to talk about % which means “of 100”.

This is not an easy paper. The authors did not formulate a hypothesis they wanted to prove. Like this it is difficult to deal with those five patients (9.6%) of the placebo group and one patient (1.9%) in the thiazide group who discontinued the medication and were simply excluded from the study. In an intention to treat analysis they would be counted as failures.
The stone-free status was examined by - examiner dependent - sonography and defined “as residual calculus size ≤4 mm in controlled ultrasonography at 2nd week, 1 month and 3 months after ESWL session.” It is not clear how many patients were stone free at week 2 and if the hydrochlorothiazide group with 76% one-session-treatments compared to 43 % in the placebo group was just responding better to ESWL. There are no data on the stone composition. The numbers are too small to talk about % which means “of 100”.